Provider Demographics
NPI:1023315017
Name:SOUTHWEST NEUROPSYCHOLOGY AND BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:SOUTHWEST NEUROPSYCHOLOGY AND BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:KURTYKA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-247-4900
Mailing Address - Street 1:320 GOLD AVE SW
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3202
Mailing Address - Country:US
Mailing Address - Phone:505-247-4900
Mailing Address - Fax:
Practice Address - Street 1:320 GOLD AVE SW
Practice Address - Street 2:SUITE 1001
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3202
Practice Address - Country:US
Practice Address - Phone:505-247-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-28
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1148103TC0700X, 103G00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty